R&R Insurance Blog

Forty-four percent of surveyed employees are concerned that their employer may reduce their benefits. As well, two-thirds are very concerned about having access to affordable health insurance as well as having enough money to cover increasing out-of-pocket medical costs.

These concerns have a negative impact on employee productivity. Employees who report being concerned about having access to affordable health insurance are also more likely to report distraction and stress at work and a decrease in their work quality.

Here are 3 ways you can reduce the stress that reform changes are having on your employees, and preserve productivity in the face of health care reform:

1. Offer supplemental Health Options
   Voluntary supplemental health benefits such as accident, critical illness, dental, disability and vision coverages help employees cope with unplanned medical costs.
2. Cultivate Wellness to Promote Productivity
   Healthy employees mean fewer costly medical interventions and absences and more productive employees. Wellness programs can work with proper communication, management buy-in and education.
3. Keep Employees in the Loop
   Health Care Reform is a complex issue, and many employees are in the dark about how it will impact them. An ongoing communication plan to keep employees informed as the company considers its options and makes decisions can reduce concerns and help maintain productivity.

At R&R, we take wellness to a whole new level. Wellness programs will increase the health and longevity of employees and their families –which means that businesses can have a lot of control over their health insurance costs and the productivity of their employees – control that they don’t know they have. At R&R Insurance, we call this program WellCompForLife!

Join the WellCompForLife discussion on LinkedIn!

For more information about WellCompForLife, about self-funding your health insurance plan, health care reform or basic employee benefits questions, contact knowledgebroker Laura Stehno.

The Affordable Health Care Act (PPACA) requirement that employers issue a formal “Notice of Exchange” previously tagged with a deadline of March 1, 2013 and indefinitely delayed, is now back on track.

Employers, whether offering a health plan or not, are required to furnish this notice to their employees before October 1, 2013.

Providing the Notice

Who Must Receive a Notice?

Employers must provide the Exchange notice to each employee, regardless of plan enrollment status or of part-time

or full-time status. Employers are not required to provide a separate notice to dependents or other individuals who are or may become eligible for coverage under the plan but who are not employees.

What Is the Deadline for Providing the Notice?

ACA required employers to provide the Exchange notice by March 1, 2013. However, on Jan. 24, 2013, the DOL announced that employers would not be held to the March 1, 2013, deadline and that employers would not have to comply with the Exchange notice requirement until more guidance was issued.

The DOL’s temporary guidance sets a compliance deadline for providing the Exchange notices that matches up with the start of the first open enrollment period under the Exchanges.

Employers must provide the Exchange notice to both new hires and current employees as follows:

• New Hires – Employers must provide the notice to each new employee at the time of hiring beginning Oct. 1, 2013. For 2014, the DOL will consider a notice to be provided at the time of hiring if the notice is provided within 14 days of an employee’s start date.
• Current Employees – With respect to employees who are current employees before Oct. 1, 2013, employers are required to provide the notice no later than Oct. 1, 2013.

Employers that decide to inform their employees about the Exchanges earlier than the Oct. 1, 2013, deadline are permitted to use the model notices and rely on the DOL’s temporary guidance.

More about Model Exchange Notices and compliance deadlines…

Helpful Links:

Model Exchange Notice: for employers who do not offer a health plan

Model Exchange Notice: For emplyers who offer a health plan to some or all employees

Do I have to comply with the Fair Labor Standads Act (FLSA)?

The IRS, EBSA and HHS developed the new group wellness program standards to implement Section 1201 of the Patient Protection and Affordable Care Act (PPACA). PPACA Section 1201 lets group health plans offer wellness programs, but it prohibits plans from using the programs to discriminate against people with health problems.

The federal agencies -- the Internal Revenue Service (IRS), the Employee Benefits Security Administration (EBSA) and the U.S. Department of Health and Human Services (HHS) -- said today they will compromise by requiring wellness incentive programs to use a "reasonable design."

"These final regulations state that a wellness program is reasonably designed if it has a reasonable chance of improving the health of, or preventing disease in, participating individuals, and is not overly burdensome, is not a subterfuge for discrimination based on a health factor, and is not highly suspect in the method chosen to promote health or prevent disease," agency officials said in a preamble to the final rule, Incentives for Nondiscriminatory Wellness Programs in Group Health Plans (CMS-9979-F) (RIN 0938-AR48).

At R&R, we take wellness to a whole new level. Wellness programs will increase the health and longevity of employees and their families –which means that businesses can have a lot control over their health insurance costs and the productivity of their employees – control that they don’t know they have. At R&R Insurance, we call this program WellCompForLife!

Join the WellCompForLife discussion on LinkedIn!

For more information about WellCompForLife, about self-funding your health insurance plan, health care reform or basic employee benefits questions, contact knowledgebroker Laura Stehno.

“Wellness” is more than just a buzzword. Wellness means having the energy and vitality to be productive, and feel and perform your best. It’s our greatest opportunity to restore Americans and American businesses to better health. Your company’s healthy journey begins now. Step by step, employee by employee, to a new culture of health and a healthier bottom line.

Take a look around. What can you do to make your worksite a healthier environment?

• Have you checked your vending machines lately?
• Got stairs? Anyone using them?
• Are you sending out reminders about how to get healthier and avoid injuries.

Helping your employees improve their health is one of the best long-term strategies for reducing your health care costs. Most people spend 53% of their waking hours at work; you have an incredible opportunity to change the lives of the people you see and work with everyday.

The single issue driving the cost of medical, pharmacy, disability, behavioral health, worker’s compensation, absenteeism and presenteeism (coming to work when you’re sick) is the lifestyle choices people make.

• Chronic conditions such as diabetes and heart disease account for 75% of our nation’s health care costs.
• Obesity costs employers $45 billion annually in medical costs and lost productivity.
• The excess cost to employers of employees who use tobacco, factoring in increased medical cost and loss of productivity increases to approximately $3,400 per year per smoking employee.

When your employees are healthy, there’s a healthy chance that:

• Productivity increases
• Premiums or total medical spending may be reduced

When your employees experience fewer health complications, the result is a healthier, more productive workforce and potentially lower overall health care costs. It’s estimated that over 10 years, cumulative medical cost savings through reduced obesity rates could reach $282.6 billion.

Your Worksite Wellness team will assist you in choosing health screenings, health seminars and other wellness events that will work best for your employees. Help employees identify possible health risks and how they can lower them and start enjoying a healthier life or understand their benefits and treatment options so they’ll be able to make more informed decisions. Once you get a good idea, you can better choose which wellness programs will go over well, so employees will be more likely to participate. Your leaders can be your best wellness champions by sending emails directly to employees encouraging them to participate. Other ideas can include:

• Decide what the focus of your program will be: awareness, education, behavior change, culture enhancement, etc.
• How often will you have an onsite program and how long will it run?
• Who’s the targeted audience: staff only, spouses, dependents, retirees?
• Consider interventions that would impact both the low-risk and high-risk staff.
• Identify incentives that will increase participation such as low cost giveaways for participation or raffle/door prizes like fitness equipment, lunches, gift certificates or even paid time off.

Your wellness team should be a winning combination of management, front line staff and employees from every health status. Lay out a specific plan for your wellness campaign.

New Interim Rules for Affordable Care Act Retaliation Claims
By Daniel Finerty, Lindner & Marsack, S.C., Posted with permission

The Affordable Care Act (ACA) created a new retaliation claim for employees to file with the Department of Labor, and in federal court, against their employer. Because of the relatively short timeframes associated with these claims, it is critical for employers to carefully document the reasons for any adverse employment decision which affects an employee who may be engaged in activity the ACA views as protected.

This summary provides additional information regarding these ACA retaliation claims, the Department of Labor’s Occupational Safety and Health Administration (OSHA) procedure, and the employee’s option to withdraw the complaint and proceed in federal court and and the employee’s option to proceed in federal court.

The “Protected Activity” Component

The ACA provides incentives to both individuals without health insurance, and to employers who do not provide health insurance, to obtain or provide health insurance. In order to carry out these mandates, Section 1558 of the ACA prohibits employers from retaliating against any employee for engaging in any activity that is protected by the ACA.

Generally, to establish a claim for retaliation under the ACA, an employee must establish (1) that s/he engaged in protected activity, (2) was subject to an adverse employment action by the employer, and (3) that the protected activity, alone or in combination with other factors, affected in some way the outcome of the employer’s decision. An employee can bring a claim for retaliation if they have suffered some adverse employment action because: • The employee receives a subsidy to purchase health insurance; •The employee provides information to an employer or a government agency regarding a real or perceived violation of the ACA; •The employee testifies in a proceeding regarding a violation of the ACA; •The employee assists or participates in an investigation of a possible violation of the ACA; or •The employee objects to or refuses to participate in any activity, policy, practice or assigned task which the employee reasonably believes to be a violation of the ACA.

The “protected activity” element may be established by the employee in a number of ways, as explained in the following examples:

Example 1: After reviewing the health insurance plan benefits offered by the employer, an employee informs the employer that s/he does not believe any of the plans offer the minimum required coverage. The employee has likely provided information to the employer regarding a real or perceived violation of the ACA and, in doing so, engaged in protected activity. If the employer subsequently disciplined or terminated the employee adverse shortly after protected activity, the action may create an inference that the protected activity was a contributing factor in the adverse action.

Example 2: After informing the employer that its health insurance plans do not provide the required minimum coverage, the employee informs the employer that s/he will secure coverage through the state’s health insurance exchange and obtain the tax credit for doing so. Because the employee has informed the employer of his or her intent to seek the subsidy, if the employer subsequently disciplines or terminates the employee as a result of a belief that the employee will seek and receive the subsidy, a finding of retaliation may result.

Example 3: After the employee obtains the tax credit and the employer is charged a penalty for failing to provide minimum coverage which pushed the employee toward the exchange. After receiving notice of the tax penalty, the employer attempts to “charge back” the penalty to the employee by reducing the employee’s wages. The employer may have just violated the ACA retaliation provision because the employee’s receipt of the tax credit is protected activity and the receipt of the tax penalty caused the employer’s decision to “charge back” the penalty against the employee’s wages.

The Department of Labor regulations specifically note that the area of employee’s receipt of the tax credit may be fertile ground for retaliation claims. Because some employers who do not offer affordable health insurance may be assessed a tax penalty by virtue of an employee’s receipt of the tax credit, “the relationship between the employee’s receipt of a credit and the potential tax penalty imposed on an employer could create an incentive for an employer to retaliate against an employee.” 78 Fed. Reg. 13,222 (Feb. 27, 2013).

The OSHA Procedure

OSHA has issued interim rules establishing the procedure for bringing these claims. To pursue a claim, an employee must file the complaint with OSHA within 180 days of the alleged violation. After filing, OSHA will share the complaint with the IRS, the Treasury Department, the Department of Health and Human Services, and/or any other relevant branches of the Department of Labor.

Initially, retaliation complaints are screened to determine if the employee has made a plausible argument that retaliation has occurred. If OSHA believes a violation may have occurred, it can issue a preliminary order reinstating the employee. Regardless of whether such an order is issued, employers typically will have twenty (20) days to submit a position statement. Sixty (60) days after filing that position statement, OSHA will issue its findings and conclusions.

If OSHA determines a violation has occurred, it can order reinstatement, back pay, compensatory damages (for emotional distress), interest on the damages awarded, attorney fees and costs. Alternatively, OSHA may find that no relation occurred and can dismiss the claim. Within 30 days of either finding, the losing party can file objections or a request for a hearing. Employers should note that OSHA may order reinstatement, even when the employer has filed objections to a finding of a violation.

An appeal of an adverse decision, including retaliation claims on which OSHA found no violation to have occurred, will lead to a hearing before an administrative law judge. At this hearing, the employee must prove that protected activity was a contributing factor in the challenged adverse employment decision.

If the employee establishes that the protected activity was one of several factors leading to the challenged employment decision, the employer then must prove, by clear and convincing evidence, that the same employment decision would have been made regardless of any protected activity.

After the hearing, the ALJ will issue a written decision. This decision becomes final unless either party files objections with the Department of Labor’s Administrative Review Board (ARB) within 14 days of the decision. The ARB has the right to accept or reject the request for review. If the ARB does not accept the request for review, the parties can appeal the ALJ’s decision to the relevant federal court of appeals. If the ARB elects to review the decision, it must issue its own decision within 120 days after all briefs have been submitted. After the ARB issues a decision, the parties then have 60 days to appeal any aspect of the ARB’s decision to the court of appeals.

The Federal Court Option

Employees also have the right to go into federal court any time before a final decision has been issued by the Department of Labor. Employees simply dismiss their administrative claim and pursue it in federal court.

One reason an employee may elect to go to federal court is that an ACA retaliation claim, if it survives an employer’s attempts to dismiss, will be tried to a jury. A jury can award the employees the same remedies in federal court, along with those the court can order, including reinstatement, back pay, compensatory damages, attorney fees and costs.

Conclusion

The retaliation provisions of the ACA create another avenue for current and former employees to challenge discharge, discipline, or any other employment decision with which they disagree. Because of the relatively short timeframes associated with these claims, it is critical for employers to carefully document the reasons for any adverse employment decision which affects an employee who may be engaged in activity the ACA views as protected.

Daniel Finerty of Lindner & Marsack, S.C. can be contacted at (414) 273-3910 or by e-mail to dfinerty@lindner-marsack.com. For more information, employers can visit the Department of Labor’s website, where the Department has posted information on filing ACA retaliation complaints at http://www.osha.gov/Publications/whistleblower/OSHAFS-3641.pdf.

© Lindner & Marsack, S.C. 2013. All Rights Reserved. The foregoing is a general discussion of a legal issue and is not intended to be, nor should it be construed as, legal advice.

Great article on improving patient safety for care giving facilities such as hospitals and nursing homes. Read full article in Amednews.com, by Kevin B. O'Reilly.

These are things hospitals and nursing homes should be doing to protect patients.

1. Improve Hand Hygiene
   Rates of hand washing are low, averaging 39%, with many doctors and nurses underestimating the activity's safety value. Research shows that effective hand hygiene initiatives improve knowledge of when to clean and how to clean, require demonstration of the knowledge, ensure that alcohol-based rub and gloves are available at the bedside, and guarantee that compliance is monitored continuously
2. Use barrier precautions to stop the spread of infections
   Along with hand hygiene, barrier precautions are key to reducing the 1.7 million health care-associated infections that occur in the U.S. each year, which the CDC says kill about 99,000 patients annually.
3. Implement care bundles to prevent central-line associated bloodstream infections
   About 250,000 bloodstream infections occur each year in the U.S., and these infections can triple hospital stays from seven to 21 days. Bloodstream infection rates in ICUs fell by nearly 60% between 2001 and 2009 thanks to wider use of a prevention protocol bundle.
4. Use real-time ultrasonography when placing central lines
   Using portable ultrasound machines to get a real-time, two-dimensional view while placing the catheter has been shown in randomized trials to lower infection rates and improve other outcomes. For every 1,000 patients, ultrasonography-guided central-line placement helps avoid 90 complications, research shows.
5. Use protocols to reduce catheter-associated urinary tract infections
   The most important step in preventing catheter-associated UTIs is to reduce use of indwelling urinary catheters. At least 21% of catheters are placed in patients inappropriately — for example, as a substitute for extra nursing care — and they often are left in long after they are needed.
6. Employ preoperative checklists to reduce surgical complications
   The most well-known surgical safety checklist is one devised in 2008 by WHO, which cut mortality rates from 1.5% to 0.8% at sites in industrialized nations and developing countries. The checklist also helped reduce the surgical complications rate from 11% to 7% over six months involving nearly 4,000 procedures.
7. Improve venous thromboembolism prophylaxis
   Between 350,000 and 600,000 Americans develop deep vein thrombosis each year. One key to improving use of these prophylactic interventions is health information technology that helps identify patients at higher risk for VTE. Medical and mechanical interventions can prevent VTE, Dr. Haut says. Low-dose unfractionated heparin and low-molecular weight heparins such as enoxaparin and warfarin are effective. So are compression stockings and pneumatic compressing devices.
8. Use preventive intervention care bundles to cut rates of ventilator-associated pneumonia
   Pneumonia linked to endotracheal intubation accounts for 25% of ICU infections and is responsible for half of intensive care antibiotic use. Research shows that preventive intervention care bundles can cut rates of ventilator-associated pneumonia by as much as 40% among adults and children.
9. Avoid hazardous drug abbreviations
   About 15,000 medication errors a year have been linked to using abbreviations such as “u” for “unit” and “q.d.” instead of “once daily.” Implementation of computerized physician order entry systems also can help eliminate the vestiges of this problem.
10. Use multi-component interventions to prevent pressure ulcers
    About 2.5 million Americans develop bedsores each year, and about 60,000 patients will die from complications related to pressure ulcers acquired in U.S. hospitals. One bundle of preventive care measures has reduced pressure ulcers by 90% at a large health system, from a rate of 5.7% of patients to less than 0.5%. The bundle, dubbed SKIN, calls for continual assessment of the skin of at-risk patients, regular turning of these patients, management of incontinence to prevent soiling that can contribute to bedsores, and nutritional assessment for malnourishment that can enable the ulcers.

Health care organizations in Wisconsin wanting to know more about how to reduce their risk and liability exposures, contact knowledgebroker Jeff Thiel.

More attention is being paid to Presenteeism than ever before. If you were to google Presenteeism, you'll get the long-standing definition: going to work while one is sick.

At R&R, we believe that Presenteeism is much more than that. We include anything that could hinder the employee from performing at their very best or maximum capacity. Of course being ill is top of the list, but here are a multitude of additional things that could cause presenteeism for your employees:

• Diabetes
• Arthritis
• Allergies
• Chronic Pain
• Migraines
• Stress
• Caregiver concerns
• Insomnia
• Financial worries
• Pre-occupation with health problems
• Depression

Employers are now understanding that they can have an enormous positive effect for the quality of life of their employees through wellness and health benefits initiatives - which will rebound into more effective and productive employees and ultimately improve the bottom line.

At R&R, we take wellness to a whole new level. Wellness programs will increase the health and longevity of employees and their families –which means that businesses can have a lot control over their health insurance costs and the productivity of their employees – control that they don’t know they have. At R&R Insurance, we call this program WellCompForLife! Join the WellCompForLife discussion on LinkedIn!

For more information about WellCompForLife, about self-funding your health insurance plan, health care reform or basic employee benefits questions, contact knowledgebroker Laura Stehno.

Maurice Evans, Jr., director of HR for Integral Group, LLC had perfect vision when he educated his workforce about the fact that diabetes can complicate vision.

If employees can't see, then they certainly can't see to do their job! Great point! Takeaway - better vision = increased productivity! Evans saw a 30% increase of vision plan participation by his employees with a little bit of education about the correlation and the benefits of good vision. read full article in Employee Benefit News.

An affordable vision plan, as well as many other voluntary benefits, can add some meat to your wellness program, increase the productivity of your employees and keep you on the front edge of competitive offerings as an employer of choice. For more information about ancillary or voluntary benefits for your employees, contact knowledgebroker Riley Enright.

At R&R, we are seeing more and more small businesses in Wisconsin having serious discussions about the link between obesity and workplace productivity. On top of that – when you factor in wellness programs that will increase the health and longevity of employees and their families – small businesses can have a lot control over their health insurance costs and the productivity of their employees – control that they don’t know they have. At R&R Insurance, we call this program WellCompForLife! Join the WellCompForLife discussion on LinkedIn!

A recent survey commissioned by Regus, a provider of flexible workplace options, revealed that stress is on the rise for workers worldwide.

Stress-related conditions account for:

• 75-90% of all doctor visits
• 30-50% of new disability benefit claims

Stunning facts from Regus stress report revealed in this infographic.

With almost half of respondents globally reporting that their stress levels have risen in the past year and the fact that work topped the chart for being the most likely stress trigger, it is evident that measures to re-address the mental well-being of staff needs to be analysed and evaluated as soon as possible.

Access the full report here at http://www.regus.com/stress-report.

At R&R, we are seeing more and more small businesses in Wisconsin having serious discussions about the link between stress, obesity, well-being, workplace injury and it's effect on health care costs. On top of that – when you factor in wellness programs that will increase the health and longevity of employees and their families – small businesses can have a lot control over their health insurance costs and the productivity of their employees – control that they don’t realize they have. At R&R Insurance, we call this program WellCompForLife! Join the WellCompForLife discussion on LinkedIn!

Related Articles:

Preventing Injuries for an Aging Workforce

Obese Workers More Likely to Report Injury

Health-Related Productivity Costs

Employers Growing Role in Chronic Condition Management

70% of all OSHA violations involve the hazard communication standard. Is your organization compliant?

According to the Department of Labor’s Occupational Health and Safety Administration (OSHA), nearly 70% of all OSHA violations involve the Hazard Communication Standard.

Are your SDS's up-to-date and compliant with the new OSHA Hazard Communication Standard based on the Globally Harmonized System (GHS)? The new standard requires organizations with employees who work with hazardous materials to have access to SDS's that are accurate and easily accessible. The OSHA changes will compel all organizations to revisit and revise their SDS’s.

New OSHA Requirements

OSHA is requiring training on the new label elements (i.e., pictograms, hazard statements, precautionary statements, and signal words) and SDS format for all employees who work around hazardous chemicals and other toxic substances. American workplaces will soon receive labels and SDSs that are consistent with the GHS.

Download a Pictogram Training Document

Effective Dates

Employees must be trained on new label elements on SDS's by December 1, 2013. More information on the new GHS deployment requirements.

Employer Responsibilities

Every organization with employees who work with hazardous materials must ensure their Safety Data Sheets are accurate and accessible. The most efficient and effective way to manage SDS’s is to use a digital database. The standard requires that organizations maintain an SDS for each chemical that is easy to access by all employees. Manual processes quickly fall out-of-date because many organizations don’t have the bandwidth to reliably keep SDS’s current and guarantee employee access, leaving them at risk of noncompliance. More information about streamlining your SDS database.

R&R's Risk Management Center Safety Data Sheet track:

• Easy login to a single point of access for all locations.
• All employees can access SDSs from any computer with internet access.
• Archive and print SDSs at your convenience.
• The RMC is fully maintained - no software updates or discs needed!

R&R Insurance Services’ Risk Management Center is a unique web-based software suite of safety and risk management tools designed to empower your organization’s risk prevention efforts. Contact knowledgebroker Jamie Vanderveldt for more information on this valuable resource for your risk management program.